Provider Demographics
NPI:1063491645
Name:WHEATON, ALLYSON L (MD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:L
Last Name:WHEATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-1408
Mailing Address - Country:US
Mailing Address - Phone:319-365-3993
Mailing Address - Fax:319-364-0116
Practice Address - Street 1:1730 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5433
Practice Address - Country:US
Practice Address - Phone:319-365-3993
Practice Address - Fax:319-364-0116
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA294662084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0128678Medicaid
IAG18353Medicare UPIN
IA0128678Medicaid